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Background: Despite national recommendations, established reimbursement mechanisms, and clinician education efforts in California family planning (FP) settings, retesting rates for female CT- and GC-positive patients remain below 50%. Previous data demonstrate that although approximately 60% of female patients return to clinic within 6 months of their CT/GC treatment, their retest is often missed.
Objectives: Institute and evaluate feasible, systems-based interventions at the clinic level to improve retesting rates by reducing missed opportunities for retesting patients who return to clinic for any reason during the 1-6-months post-treatment.
Methods: In 2010, after evaluating existing protocols and electronic systems at six California FP clinics, we launched clinic-level interventions emphasizing automated electronic reminders, or “pop-ups”, which identified at check-in when presenting patients were due for retesting. The outcome of interest was the overall retesting rate during the 31-180 days post CT/GC treatment. A sample of medical records was abstracted to collect CT/GC testing data. Fisher’s exact test was used to compare differences in rates before and after the intervention.
Results: Based on preliminary data from four of the six clinics, the overall retesting rate prior to the intervention was 17% (range 9-48%). After the introduction of pop-up reminders, overall retesting rates increased by 112% (p<0.0001); however, increases in rates varied among the four clinic sites: 15%, 84%, 100%, and 178%.
Conclusions: By employing automated pop-up reminders that identified patients at check-in, we were able to successfully improve overall CT/GC retesting rates. This intervention is low cost and can be easily implemented in clinics with electronic medical record or billing systems.
Implications for Programs, Policy, and Research: Automated, clinic systems-level interventions, such as pop-up reminders, may have a more consistent impact on improving clinical services as they do not rely on either the patient’s initiative in requesting services or the clinician’s capacity to reliably remember all newly recommended follow-up protocols.